PREGNANCY

SUPPORTING PREGNANCY WITH MASSAGE THERAPY

by Carole Osborne-Sheets

Nurturing touch during pregnancy, labor, and the postpartum period is not a new concept. According to cultural and anthropological studies, massage and movement during the childbearing experience was and continues to be a prominent part of many healthcare approaches.[1]  Midwives, the traditional providers of maternity care worldwide, have highly developed hands-on skills.

Some studies also indicate that the more frequently touch is used to communicate affection and nurturing to expectant women and young children the more peaceful that culture will be.[2] In contrast, many modern, “high tech” cultures are noticeably “low touch”, and, in most cases, more violent.

Current research provides a contemporary basis for the reintroduction of touch into these societies. Scientists have found that pregnant rats restricted from cutaneous self-stimulation had poorly developed placentas and 50% less mammary gland development. Their litters were often ill, stillborn, or died shortly after birth due to poor mothering skills.[3]  Studies show that when women received nurturing touch during later pregnancy they touch their babies more frequently and lovingly.[4]  Pregnant women massaged twice weekly for 5 weeks experienced less anxiety and less leg and back pain. They reported better sleep and improved moods, and their labors had fewer complications, including less premature births.[5]  During labor the presence of a doula, a woman providing physical and emotional support, including extensive touching and massage, drastically reduces the length of labor and number of complications, interventions, medications, and Cesareans.[6]

Why Prenatal Massage Therapy?

Changes during pregnancy span the physiological, structural, functional, psychological, social, and spiritual realms. While pregnancy is a welcome blessing for most, it can bring with it apprehension as well. Massage therapy can help a woman approach her due date with less of this anxiety, and less physical discomfort too.

Profound local and systemic changes in a woman’s physiology occur as a result of conception and the process of labor. To provide for fetal needs, the circulatory system adapts in numerous ways. Resulting discomforts, such as edema, varicose veins, and complications including high blood pressure can occur. Hormonal changes provoke indigestion, heartburn, nausea, or vomiting in some women. Rapid, shallow, upper chest breathing develops as the growing uterus restricts diaphragm excursion and her pectoral girdle shifts more anterior. This restricted breathing can lead to physical discomforts and can interfere with attempts to counteract stressful stimulation with deeper breathing.

Although altered physiological functioning can produce the discomforts described above, most maternity massage therapists find that musculoskeletal strain and pain relief is the primary motivator for their clients seeking therapy. Consider the vast structural changes an expectant woman’s body must make, and this need is clearly understandable.

More anterior weight in the breasts and abdomen generally challenges a pregnant woman’s structural integrity. As pregnancy progresses, her pelvis will tend to anteriorly rotate, spilling the uterus forward against the abdominal walls. This increases the lumbar curvature and stretches the abdominal muscles, usually separating the rectus abdominis at the linea alba (diastus recti) by the third trimester. To compensate, she leans her upper ribcage more posterior, and her head and neck jut forward anterior of the optimal vertical line. These compensations strain all of the posterior musculature creating fatigue, tightness, excessive fibrous buildup (fibrosis), and hyperirritable, tender points that refer pain to distant sites (myofascial trigger points). Her pectoral girdle sags into forward rotation. Increased uterine weight encourages strain to the pelvic floor; external rotation of the hip joint; modifications of iliopsoas function in walking; and causes the characteristic waddling gait of pregnant women. To prevent falling forward with the increased anterior weight, her knees hyperextend, and her calves frequently cramp. She tends to collapse her increased weight into the medial arches of her weary feet. As her hair changes texture and her skin darkens in several areas, it’s no wonder that a woman may feel as though she is no longer her former self.

Pregnancy is often a time of emotional upheaval and anxiety, as well as a time of euphoria and joy. Each day an expectant woman’s emotions may fluctuate vastly. Her relationships with her mate, parents, friends, and co-workers are in flux. Life issue challenges, independence and financial concerns, and alterations in her sense of her societal roles often arise at this time. Many American women find themselves isolated, and an alarming number of women also suffer abuse from their partners.[7]  They may be planning on only one or two children, and their childbearing expectations are often romanticized or idealized. The resulting pressure some women feel for the “ideal” pregnancy and birth can be extreme. Fears about the upcoming birth and health issues for the mother and baby also can add to a woman’s apprehension about the pregnancy’s outcome.

With all of these concerns, expectant women will usually experience increased stress. This can have significant negative impacts on fetal development and the birth. Research reveals that stress has many deleterious effects pre- and perinatally including:

• increased maternal heart rate, blood pressure, vomiting, nausea, spontaneous abortion, toxemia, and immune system dysfunction
• reduced blood supply to uterus, by as much as 65%, resulting in lower fetal heart rate and reduced blood oxygenation
• interference with fetal brain and central nervous system development
• higher incidence of miscarriage, prematurity, prolonged labors with more complications, and postpartum complications
• increased perinatal fetal distress, low birth weight, and infant irritability, restlessness, crying, and digestive disturbances[8],[9]

Types of prenatal massage therapy

A typical maternity massage therapy session can address pregnancy’s various physical challenges: edema, gastrointestinal discomforts, postural changes, and pain in the lower back, pelvis, or hips. Swedish massage may facilitate gestation by supporting cardiac function, placental and mammary development,[10]  and increasing cellular respiration. It also reduces edema and contributes to sympathetic nervous system sedation.[11]  Deep tissue, trigger point, and both active and passive movements alleviate stress on weight-bearing joints and myofascial structures, especially the sacroiliac and lumbosacral joints, lumbar spine, hips, and pelvic and spinal musculature.[12]  Structural balancing and postural reeducation reduce neck and back pain caused by improper posture and strain to the uterine ligaments. Prenatal massage therapy also can facilitate ease of labor by preparing the muscles for release and support during childbirth.

Beyond these physical effects, an effective prenatal massage therapy session provides emotional support. In the safe care of a focused, nurturing therapist, many women unburden their worries, fears, and other anxieties about childbearing. Individualized hands-on time with a somatic practitioner presents a unique and potent experience of support and relaxation for pregnant women. In contrast to the effects of stress, support and relaxation activate the parasympathetic branch of the autonomic nervous system, increasing steroid production. This helps create balance in the body and encourages a healthy, smoothly functioning state, characterized by steady blood pressure, pulse, and respiratory rate; regular blood flow to uterus, placenta, and fetus; healthy immune system functioning, emotional states, and response to stressful stimuli; and reduced fear and anxiety.[13]

An overview of research indicates that support can counteract the negative effects of stress. Women in these studies who also had strong support systems had one-third the complications of those who experienced similar stresses without a support system.[14]  A massage practitioner provides soothing, nurturing touch combined with focused, individualized attention to the pregnant woman’s physical and emotional concerns. This regular, caring contact can be a vital component of an expectant woman’s support system, especially when family and friends are not providing such support.

Practitioners with complementary skills and training in communication and emotional processing can offer attentive, nonjudgmental listening. This presents additional opportunities for helping women to understand and assimilate the strong emotional states that some women experience during pregnancy. Practitioners can also educate women in body-use that assists in managing and reducing stress. They sometimes provide well-researched referrals to other professionals who deal with more complex pre- and perinatal health and psychological issues.

In many cases bodywork helps the mother-to-be develop the sensory awareness necessary to birth more comfortably and actively. Massage therapy can be profoundly relaxing, and it can provide an experience of “letting go” and focusing inwardly. It can create the same positive physiologic states and increased alpha brain wave activity as meditation. Variations in pressure, rhythm, and positioning flood the sensory nerve pathways with input that can increase body awareness and override signals of pain and stress.[15]  Laboring women whose partners learned and provided basic massage strokes to their backs and legs had shorter, less complicated labors.[16]  Imagine the benefits generated by the skilled hands of a trained touch specialist!

The Postpartum Period

Beginning with the baby’s birth, a new mother must cope with more changes. She is typically only 10 to 12 pounds lighter, yet she often still maintains her body in an anterior weight load posture. The massage practitioner can facilitate proprioceptive reprogramming to gently return the body to its pre-pregnancy state, to alleviate pain, and to bring about a renewed sense of body and self.

As a specialist in postpartum work, practitioners can focus on repositioning the pelvis and repatterning overall body use. Postpartum massage sessions can restore functional muscle use in the lumbar spine area, as well as strengthen and increase tonus in the abdominal musculature stretched and separated by pregnancy. Additionally, the overtaxed, hypotoned iliopsoas muscles’ functions can be improved. Upper back muscles, which now support larger breasts and the carried infant’s weight, need work to reduce strain, and to help maintain flexibility despite the physical stresses of infant feeding and care. For post-Cesarean mothers, specific therapeutic techniques also can reduce scar tissue formation[17]  and facilitate the healing of the incision and related soft tissue areas, as well as support the somato-emotional integration of her childbearing experience.

Pre- & Perinatal Massage Therapy Education

To safely massage pregnant, laboring and postpartum women, it is imperative that practitioners be knowledgeable about normal pre- and perinatal physiology, high risk factors, and complications of pregnancy. Every pregnancy necessitates a variety of adaptations to aspects of routine massage practices. Various techniques and methodologies must be modified or eliminated, depending on the individual and the trimester of pregnancy. Consultation with physicians and/or midwives concerning prospective and on-going massage therapy is often beneficial, and it becomes a necessity when maternal or fetal progression deviates from normal expectations.

Pre- and Perinatal Massage Therapy: A Comprehensive Practioners’ Guide to Pregnancy, Labor, Postpartum, offers detailed, research- based protocols, contraindications, and guidance. Practitioners with clients having low-risk, uncomplicated pregnancies may find this information adequate for their needs. For those wanting to specialize in working with all types of pregnancies, comprehensive hands-on training, beyond what is usually included in basic massage therapy programs, is highly recommended. Certification in a maternity massage specialist course, generally around 32 hours, is available as continuing education workshops. When working with other than normal, low risk pregnancies, this level of training becomes imperative. (See author’s website, bodytherapyeducation.com, for information and scheduled certification courses.)

[1]  Goldsmith, Judith. Childbirth Wisdom. New York: Congdon and Weed, 1984.

[2]  Prescott, James. “The Origins of Love & Violence and the Developing Human Brain.” Touch the Future, Long Beach, CA, Fall, 1995, p. 9-15.

[3]  Rosenblatt, J.S. and D.S. Lehrman. “Maternal behavior of the laboratory rat”. Maternal Behavior in Mammals, Wiley, New York, 1963, p. 14.

[4]  Rubin, R. Maternal Touch. Nurs Outlook, 11/1963, p. 828-31

[5]  Field, T. M. Hernandez-Reif, S. Hart, H. Theakston, S. Schanberg, and C. Kuhn. “Pregnant women benefit from massage therapy”. J. Psychosomatic Obstetrics and Gynecology, 20(1), March, 1999, p. 31-8.

[6]  Kennell, J.H., M.H. Klaus, S. McGrath, S. Robertson, C. Hinkley. “Continuous emotional support during labor in a US hospital”. J Am Med Assoc, 265, 1991, p. 2197-2201

[7]  Helton, A.S., McFarlane, J., & Anderson, E.T. “Battered and pregnant: a prevalence study.” American Journal of Public Health 77, p. 1337-39.

[8]  Gorsuch, R. and Key, M. “Abnormalities of pregnancy as a function of anxiety and life stress.” Psychosomatic Medicine, 36:1974, p. 353.

[9]  Cranden, A. “Maternal anxiety and obstetric complications.” Journal of Psychosomatic Research, 23: 1979, p. 109.

[10]  Rosenblatt, Op cit.

[11]  Zanolla, R., Monzeglio, C., Balzarini, A., et al. “Evaluations of the results of three different methods of post-mastectomy lymphedema treatment.” J. Surg. Oncol. 26:1984, p. 210-13.

[12]  Quebec Task Force on Spinal Disorders.. “Scientific approach to the assessment and management of activity-related spinal disorders.” Spine, 12, Supplement 1:1987.

[13]  Samuels, Mike and Nancy. The New Well Pregnancy Book. Fireside: New York, 1996, p. 261.

[14]  Nuckolls, K., et. al. “Psychosocial assets, life crises and the prognosis of pregnancy.” American Journal of Epidemiology 95: 1972, p. 431.

[15]  Juhan, Deane. Job’s Body: A Handbook for Bodywork. Station Hill Press: New York, 1987, p. 294.

[16]  Field, T., Hernandez-Reif, M., Taylor, S., & Quintino, 0., & Burman, I. “Labor pain is reduced by massage therapy”. Journal of Psychosomatic Obstetrics and Gynecology, 18:1997, p. 286-291.

[17]  Hufnagel, V., M.D. “Medical basis for using massage after surgery.” Massage Magazine #17, Dec-Jan/1988-89, p. 21.